OBJECTIVE： To systematically review the effects of long-term oral low-dose of azithromycin on pulmonary function and clinical signs of patients with stable COPD. METHODS： Retrieved from PubMed， Medline， CJFD， VIP and Wanfang database， randomized controlled trials （RCTs） about long-term oral low-doses of azithromycin for stable COPD were collected. After quality evaluation according to modified Jadad scale， Meta-analysis was conducted by Rev Man 5.2 statistical software. RESULTS： A total of 13 RCTs were included， involving 1 207 patients. Meta-analysis showed that， long-term oral low-doses of azithromycin could significantly improve FEV1[SMD＝0.78，95％CI（0.62，0.93），P＜0.001]， FEV1％[SMD＝0.81，95％CI（0.61，1.00），P＜0.001]， FEV1/FVC [SMD＝3.91，95％CI（2.58，5.24），P＜0.001] and 6MWD[SMD＝23.74，95％CI（21.20，26.18），P＜0.001] in stable COPD patients，meanwhile significantly reduce dyspnea score [SMD＝－1.15，95％CI（－1.60，－0.71），P＜0.001]， quality of life score [SMD＝－1.82，95％CI（－2.74，－0.90），P＜0.001] and 24 h sputum volume[SMD＝－18.68，95％CI（－24.79，－12.56），P＜0.001]， with statistical significance. CONCLUSIONS： Long-term oral low-doses of azithromycin can improve pulmonary function， dyspnea，activity tolerance and quality of life in acute exacerbation of COPD patients.